Library

X
feed icon rss

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Electronic Resource
    Electronic Resource
    Generalisierte Gasbrandinfektion mit Rhabdomyolyse nach Cholezystektomie (1997)
    Springer
    Der Anaesthesist 46 (1997), S. 207-210 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Cholezystektomie ; Clostridium perfringens ; Gasbrand ; Rhabdomyolyse ; Sepsis ; Key words Cholecystectomy ; Gas gangrene ; Clostridium perfringens ; Rhabdomyolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract We report a rare case of spontaneously developing generalised gas gangrene with massive rhabdomyolysis after a cholecystectomy and drainage of a hepatic abscess. On preoperative physical examination the patient appeared severely ill and was icteric and oliguric. Laboratory evaluation showed signs of systemic inflammation, elevated lactate levels, evidence of disseminated intravascular coagulation (DIC), and increased levels of serum creatine kinase (CK) activity. Abdominal ultrasound and endoscopic retrograde cholangiography showed a gallbladder perforation and a hepatic abscess. Cholecystectomy and drainage of the abscess was performed immediately and without technical problems. After postoperative admission to the intensive care unit, the patient showed evidence of generalised myonecrosis with subcutaneous gas formation and acute renal failure. Initially, there were few other signs of systemic toxicity; the patient was not hypotensive and the pulmonary gas exchange was normal. Within hours diffuse swelling of his right leg developed with cutaneous gangrene and a compartment syndrome. After fasciectomy and extensive surgical debridement, uncontrollable bleeding due to DIC developed from the fasciectomy site, which finally required exarticulation of the leg at the hip joint. At this point, multiple organ failure including severe adult respiratory distress syndrome was present. Two days after cholecystectomy, the patient died from hypoxic cardiocirculatory failure. Clostridium perfringens was repeatedly isolated from the wounds. Besides gas gangrene, the differential diagnosis of such infections includes localised clostridial cellulitis, nonclostridial anaerobic cellulitis caused by mixed aerobes and anaerobes, and type I or type II necrotising fasciitis. Patients with systemic necrotising infections should be treated with broad-spectrum antimicrobial regimens (penicillin G, 3rd generation cephalosporins, clindamycin, and aminoglycosides). An otherwise unexplained elevation of serum CK activity in the presence of acute cholecystitis may suggest haematologic spread of an aggressive myolytic agent and the beginning of myonecrosis. This should prompt immediate surgical exploration after establishing broad-spectrum antibiotic coverage. The role of hyperbaric oxygen treatment in this situation remains to be established. If hyperbaric oxygen is to be employed, it should neither delay surgical exploration nor jeopardise the patient with the hazards of an interhospital transport.
    Notes: Zusammenfassung Kasuistik: Wir berichten über den seltenen Fall einer spontan aufgetretenen Gasbrandinfektion mit generalisierter Rhabdomyolyse bei einem 64jährigen Patienten nach Cholezystektomie wegen einer perforierten Cholezystitis. Präoperativ war bei dem Patienten neben laborchemischen Entzündungszeichen besonders eine isolierte Erhöhung der Kreatinkinasekonzentration im Serum auffällig. Er entwickelte nach der Cholezystektomie eine generalisierte nekrotisierende Weichteilinfektion mit Hautemphysem und Rhabdomyolyse. Innerhalb von Stunden kam es zu einem Kompartmentsyndrom im Bereich des rechten Ober- und Unterschenkels. Trotz einer Faszienspaltung und einer späteren Exartikulation im Hüftgelenk entwickelte der Patient eine generalisierte Gasbrandinfektion mit disseminierter intravasaler Gerinnung. Der Patient verstarb zwei Tage nach Krankenhausaufnahme. Mikrobiologisch fand sich in den Wundabstrichen Clostridium perfringens. Differentialdiagnostisch ist bei derartigen fulminant verlaufenden Krankheitsbildern vor allem an eine Infektion durch Clostridien oder andere Anaerobier sowie an eine nekrotisierende Fasziitis Typ I oder Typ II zu denken. Therapie: Die gezielte und sofort zu beginnende Antibiotikatherapie sollte neben Penicillin G auch ein Cephalosporin der 3. Generation, Clindamycin und ein Aminoglykosid umfassen. Bei einer anderen Ursachen nicht zuzuordnenden Erhöhung der Kreatinkinase bei Cholezystitis muß an das Vorliegen einer disseminierten Infektion mit Myonekrose gedacht werden. Der Einsatz der hyperbaren Oxygenation in einer derartigen Situation kann erwogen werden, diese Maßnahme darf aber weder ein entschlossenes chirurgisches Vorgehen verzögern noch den Patienten zusätzlich gefährden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050393
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Gesundheitsbezogene Lebensqualität Langzeitüberlebende, erwachsene Patienten mit ARDS nach extrakorporaler Membranoxygenation (ECMO) (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 24-29 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Akutes Lungenversagen ; Extrakorporale Membranoxygenierung ; Gesundheitsbezogene Lebensqualität ; SF-36 ; Key words Respiratory distress syndrome ; adult ; Extracorporeal membrane oygenation ; Health-related quality of life ; SF-36 ; Intensive care treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Treatment of severe acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) can be life-saving but requires maximal use of intensive care resources over prolonged periods of time, resulting in high costs. Little is known about the health-related quality of life (HRQL) in long-term survivors. This case-controlled retrospective study was designed to assess the health-related quality of life in long-term survivors of ARDS and ECMO-therapy. Methods: 14 long-term survivors of ARDS (APACHE II score=24, Lung Injury Score=3.25, median values) treated using ECMO between 1992 and 1995 (median time interval between data collection and discharge from the ICU 16 months) and 14 ARDS-patients conventionally treated during the same period (group I) were identified and completed the SF-36 Health Status Questionnaire (Medical Outcome Trust, Boston, USA). 14 healthy subjects (group II) were drawn at random from a large data base generated to provide normal values for the SF-36 in a German population. All three groups were comparable with respect to sex and age. Results: Long-term survivors of ECMO-therapy reported significant reductions in physical functioning when compared with patients treated by mechanical ventilation alone (group I, –12.5%, p〈0.05) and with healthy controls (group II, –50%, p〈0.05) and showed a higher incidence of chronic physical pain (+5% and +24%, respectively, p〈0.05). There were no differences with regard to the mental health dimensions of the SF-36 (e.g. vitality, mental health index or social functioning) between ECMO-patients and all controls. Nine patients (64.3%) from the ECMO group versus all patients treated conventionally (group I) had full-time employment (p=0.46, Chi2 test). Conclusions: The majority of long-term survivors of ECMO-treatment show good physical and social functioning, including a high rate of employment. The more aggressive approach of ECMO-therapy and a possibly more severe underlying disease process may explain impairments in health-related quality of life outcomes after ECMO-treatment. Despite these limitations, long-term survivors of ECMO-therapy are able to reach a highly satisfactory health-related quality of life.
    Notes: Zusammenfassung Einführung und Methodik: Die extrakorporale Membranoxigenation (ECMO) zur Behandlung des schweren ARDS beim Erwachsenen ist eine aufwendige und teure Methode und in Einzelfällen lebensrettend. Es existieren jedoch keine Daten zur gesundheitsbezogenen Lebensqualität (HRQL) von langzeitüberlebenden Patienten nach ECMO-Behandlung. Wir untersuchten daher 14 Patienten, die zwischen 1992 und 1995 mittels extrakorporaler Membranoxygenation behandelt wurden bezüglich der erreichten HRQL. 14 im gleichen Zeitraum konventionell therapierte ARDS Patienten (Gruppe I) und 14 gesunde Normalpersonen (Gruppe II) dienten als Kontrollen. HRQL wurde mit einem standardisierten und validierten Fragebogen (SF-36) erfaßt. Ergebnisse: ECMO-Patienten zeigten im Vergleich zu beiden Kontrollen eine schlechtere körperliche Funktionsfähigkeit um 12,5% (Gruppe I) bzw. 50% (Gruppe II) (p〈0,05) und eine höhere Inzidenz körperlicher Schmerzen (+5% bzw. +24%, p〈0,05). Demgegenüber war die psychische Gesundheit, die Vitalität und die soziale Funktionsfähigkeit der ECMO-Patienten im Vergleich zu den gesunden Kontrollen nur gering eingeschränkt (p〉0,05). Schlußfolgerung: Patienten nach ECMO-Behandlung des ARDS erreichen eine insgesamt zufriedenstellende HRQL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050518
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    ARDS und Wegener-Granulomatose (1997)
    Springer
    Der Anaesthesist 46 (1997), S. 969-973 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Wegener-Granulomatose ; Glomerulonephritis ; ARDS ; Extrakorporale Membranoxygenation ; ECMO ; Key words Wegener’s granulomatosis ; Glomerulonephritis ; Respiratory distress syndrom ; Adult ; Extracorporeal membrane oxygenation ; ECMO
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Wegener’s granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and glomerulonephritis. This disease can present as a clinical picture which resembles sepsis and adult respiratory distress syndrome (ARDS). Wegener’s disease requires immunosuppression which can have detrimental consequences when used in sepsis. The following case report illustrates the diagnostic difficulties encountered by intensiv care physicians treating severe pulmonary failure and multiple organ dysfunction in Wegener’s granulomatosis appearing as ARDS with sepsis. Case report: A 19-year-old female patient had developed acute respiratory and renal failure after a prolonged period (many months) of antibiotic resistant otitis, sinusitis and mastoiditis. The patient had required intubation at another hospital and there was a history of tension pneumothorax and cardiopulmonary resuscitation during mechanical ventilation. Emergency extracorporeal membrane oxygenation (ECMO) for acute hypercapnic and hypoxic respiratory failure was instituted and the patient was transported to our institution while on ECMO. The patient was treated empirically for suspected pulmonary and systemic infection and received hydrocortisone (0,18 mg/kg/h) as part of a protocol-driven treatment of septic shock in addition to antibiotic and antimycotic regime. The use of ECMO was required for 10 and mechanical ventilation for another 50 days after admission. After successfull extubation, central nervous system dysfunction became evident with a somnolent and generally unresponsive patient. When the hydrocortisone dose was gradually tapered, the clinical status of the patient further deteriorated, pulmonary gas exchange worsened and she developed renal failure with proteinura and hematuria. A renal biopsy was performed demonstrating vasculitis and focal segmental glomerulonephritis, a systemic granulomatous vasculitis was suspected; the serum was tested for anti-proteinase 3 antibodies (PR3-ANCA) and turned out to be positive (17.5 U/ml; normal range 〈7 U/ml). The morphologic findings from renal biopsy, the positive test for antiproteinase 3 antibodies and the pulmonary-renal involvement with evidence of multisystem disease established the diagnosis of Wegener’s granulomatosis. Immunosuppressive therapy with cyclophosphamide and prednisolon was instituted resulting in rapid improvement with recovery of pulmonary, renal and central nervous system function within two weeks. The use of ECMO in this patient served as a life – saving immediate measure usefull to ”buy time” until a definite diagnosis could be established. ARDS represents an uniform pulmonary reaction to a large number of different noxious stimuli and disease entities. This case demonstrates that intensiv care physicians caring for critically ill patients with ARDS should include even rare causes of pulmonary injury into their differential diagnosis.
    Notes: Zusammenfassung Wir berichten über eine 19jährige Patientin, bei der unter dem typischen Bild eines schweren ARDS mit Multiorganversagen für insgesamt 10 Tage der Einsatz einer extrakorporalen Lungenersatztherapie (ECMO) erforderlich war. Therapieverlauf: Unter einer kalkulierten antibiotischen und antimykotischen Therapie sowie einer Behandlung mit Hydrocortison als adjuvanter Therapie bei septischem Schock besserte sich erst nach wochenlangem und kompliziertem klinischen Verlauf die Lungenfunktion soweit, daß eine Extubation möglich war. Die Patientin zeigte jedoch unverändert eine Mehrorgandysfunktion von Niere, Lunge und ZNS. In den folgenden Wochen nach Beendigung der Hydrocortisontherapie verschlechterten sich Nierenfunktion, pulmonaler Gasaustausch und Vigilanz wieder. Diagnostik: Der histologische Befund der Nierenbiopsie mit Arteriitis und Glomerulonephritis bei beidseitiger Vergrößerung der Nieren im CT und der Nachweis von Proteinase 3-ANCA im Serum ermöglichten letztlich bei Würdigung des gesamten klinischen Bildes und seiner genauen Vorgeschichte eine Diagnose: Wegener-Granulomatose. Durch immunsuppressive Therapie kam es innerhalb kurzer Zeit zu einer Remission mit vollständiger Erholung insbesondere der ZNS-Funktion. Schlußfolgerung: Dieser Fallbericht zeigt, daß im Einzelfall auch seltene Krankheitsbilder mit pulmonaler Beteiligung wie die Wegener-Granulomatose in die Differentialdiagnose des ARDS einbezogen werden müssen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050494
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Akutes Nierenversagen Pathophysiologie – klinische Beurteilung – Therapie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 349-352 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Akutes Nierenversagen ; Pathophysiologie ; Klinik ; Therapie ; Key words Acute renal failure ; Pathophysiology ; Diagnosis ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Acute renal failure (ARF) is characterized by an acute decrease in glomerular filtration rate (GFR). ARF complicates 4% to 23% of intensive care unit admissions, and is associated with a mortality of approximately 50% among critically ill patients. In the intensive care setting the term ARF is usually applied to acute tubular necrosis (ATN), a form of intrinsic ARF caused by ischemia or nephrotoxins. Pathophysiological mechanisms involved in the decline in GFR include tubular obstruction caused by detachment of tubular epithelial cells from the basement membrane and backleak of glomerular filtrate as a consequence of disruption of the epithelial cell layer. Vascular mechanisms involved in the pathophysiology of ATN are vasoconstriction due to an imbalance between vasoconstrictive and vasodilatatory mediators and vascular obstruction caused by cell aggregation. Currently, there is no real time method to monitor renal function comparable to the real time monitoring of blood pressure or arterial oxygen saturation. Urinary output does not reflect glomerular filtration which may be critically reduced despite normal urine volumes and creatinine clearance still provides the clinically most applicable estimate of GFR. Tubular function can be assessed using the fractional excretion of sodium or the ratio of urinary and serum osmolality; both parameters can be obtained from spot samples of urine and serum and no urinary sampling period is necessary. However, both parameters are strongly affected by the administration of loop diuretics and high fluid and sodium inputs which are common in the intensive care unit. We determined the day to day variability of creatinine clearance, fractional excretion of sodium and the urinary to serum osmolality ratio in critically ill patients without renal dysfunction (i.e. creatinine clearance in the normal range) and found differences of 16% for creatinine clearance, 79% for fractional excretion of sodium and 22% for urinary to serum osmolality ratio. Treatment of ARF is mainly supportive and there is no clinically accepted therapy that attenuates the course of ATN. Treatment of the underlying disease and renal replacement therapy are the main options for the treatment of patients with ARF. In critically ill patients continuous veno-venous hemo(dia)filtration is the first choice because it provides more hemodynamic and metabolic stability than intermittent therapy. Acute lifethreatening hyperkalemia is an indication for intermittent hemodialysis because of the higher efficacy of dialysis in the clearance of low molecular weight substances.
    Notes: Zusammenfassung In der operativen Intensivmedizin spielt die als akute Tubulusnekrose bezeichnete Form des intrarenalen akuten Nierenversagens die größte Rolle. Ursachen sind meist Ischämie und Nephrotoxizität, oft im Rahmen von Sepsis, Trauma oder großen operativen Eingriffen. Wesentliche pathophysiologische Mechanismen spielen sich am Tubulus (Obstruktion und “Back-leak”) und an den Blutgefäßen (Vasokonstriktion und Gefäßobstruktion) ab. Zur Beurteilung der Nierenfunktion auf der Intensivstation eignen sich die Kreatinin-Clearance als Schätzwert für die glomeruläre Filtrationsrate und die fraktionelle Natriumexkretion sowie das Verhältnis von Urin- zu Serumosmolalität als Parameter der Tubulusfunktion. Letztere werden durch Volumen- bzw. Natriumzufuhr und Schleifendiuretika stark beeinflusst und sind daher in der Intensivmedizin nur von begrenztem Nutzen. Die Therapie der Grundkrankheit ist die einzige kausale Behandlung des akuten Nierenversagens. Eine medikamentöse Beeinflussung des akuten Nierenversagens an sich ist bisher nicht möglich. Nierenersatzverfahren haben heute einen hohen technischen Standard erreicht. Für Intensivpatienten ist die pumpengetriebene veno-venöse Hämo(dia)filtration das Verfahren der Wahl. Zur Behandlung der lebensbedrohlichen Hyperkaliämie und bei Patienten mit Kontraindikationen für eine Antikoagulation ist die intermittierende Hämodialyse besser geeignet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050841
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Effects of noninvasive positive pressure ventilatory support in non-COPD patients with acute respiratory insufficiency after early extubation (1999)
    Springer
    Intensive care medicine 25 (1999), S. 1374-1380 
    Details
    ISSN: 1432-1238
    Keywords: Key words Noninvasive mechanical ventilation ; Pressure support ventilation ; Continuous positive airways pressure ; Weaning criteria ; Respiratory failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate the effects of noninvasive positive pressure ventilation (NPPV) on pulmonary gas exchange, breathing pattern, intrapulmonary shunt fraction, oxygen consumption, and resting energy expenditure in patients with persistent acute respiratory failure but without chronic obstructive pulmonary disease (COPD) after early extubation. Design: Prospective study. Setting: Multidisciplinary intensive care unit of a university hospital. Patients: 15 patients after prolonged mechanical ventilation (〉 72 h) with acute respiratory insufficiency after early extubation. Interventions: Criteria for early extubation were arterial oxygen tension (PaO2) L 40 mm Hg (fractional inspired oxygen 0.21), arterial carbon dioxide tension (PaCO2) K 55 mm Hg, pH 〉 7.32, respiratory rate K 40 breaths per min, tidal volume (VT) L 3 ml/kg, rapid shallow breathing index K 190 and negative inspiratory force L 20 cmH2O. After extubation, two modes of NPPV were applied [continuous positive airway pressure (CPAP) of 5 cmH2O and pressure support ventilation (PSV) with 15 cmH2O pressure support]. Measurements and main results: Oxygenation and ventilatory parameters improved during both modes of NPPV (p 〈 0.05): increase in PaO2 of 11 mm Hg during CPAP and 21 mm Hg during PSV; decrease in intrapulmonary shunt fraction of 7 % during CPAP and 12 % during PSV; increase in tidal volume of 1 ml/kg during CPAP and 4 ml/kg during PSV; decrease in respiratory rate 6 breaths/min during CPAP and 9 breaths/min during PSV. Oxygen consumption (15 % during CPAP, 22 % during PSV) and resting energy expenditure (12 % during CPAP, 20 % during PSV) were reduced (p 〈 0.05). PaCO2 decreased, whereas minute ventilation and pH increased during PSV (p 〈 0.05). The median duration of NPPV was 2 days. Two patients had to be reintubated. Conclusions: In non-COPD patients with persistent acute respiratory failure after early extubation, NPPV improved pulmonary gas exchange and breathing pattern, decreased intrapulmonary shunt fraction, and reduced the work of breathing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051084
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 6
    Electronic Resource
    Electronic Resource
    Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment (1999)
    Springer
    Intensive care medicine 25 (1999), S. 697-704 
    Details
    ISSN: 1432-1238
    Keywords: Key words Intensive care ; Post-traumatic stress disorder ; Questionnaire ; Recall ; Memory ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Many survivors of critical illness and intensive care unit (ICU) treatment have traumatic memories such as nightmares, panic or pain which can be associated with the development of post-traumatic stress disorder (PTSD). In order to simplify the rapid and early detection of PTSD in such patients, we modified an existing questionnaire for diagnosis of PTSD and validated the instrument in a cohort of ARDS patients after long-term ICU therapy. Design: Follow-up cohort study. Setting: The 20-bed ICU of a university teaching hospital. Patients: A cohort of 52 long-term survivors of the acute respiratory distress syndrome (ARDS). Interventions and measurements: The questionnaire was administered to the study cohort at two time points 2 years apart. At the second evaluation, the patients underwent a structured interview with two trained psychiatrists to diagnose PTSD according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. The reliability and validity of the questionnaire was then estimated and its specificity, sensitivity and optimal decision threshold determined using receiver operating characteristic (ROC) curve analyses. Results: The questionnaire showed a high internal consistency (Crohnbach's α = 0.93) and a high test-retest reliability (intraclass correlation coefficient α = 0.89). There was evidence of construct validity by a linear relationship between scores and the number of traumatic memories from the ICU the patients described (Spearman's ϱ = 0.48, p 〈 0.01). Criterion validity was demonstrated by ROC curve analyses resulting in a sensitivity of 77.0 % and a specificity of 97.5 % for the diagnosis of PTSD. Conclusions: The questionnaire was found to be a responsive, valid and reliable instrument to screen survivors of intensive care for PTSD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050932
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 7
    Electronic Resource
    Electronic Resource
    A comparison of the adrenocortical response during septic shock and after complete recovery (1996)
    Springer
    Intensive care medicine 22 (1996), S. 894-899 
    Details
    ISSN: 1432-1238
    Keywords: Septic shock ; Cortisol ; ACTH ; Adrenocortical insufficiency ; Hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To compare the adrenocortical response to corticotropin during septic shock and after complete recovery. Design Prospective clinical study. Setting Multidisciplinary intensive care unit in a university hospital. Patients 20 consecutive patients surviving septic shock. All patients met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock. In addition, the presence of high-output circulatory failure with a cardiac index 〉41/min per m2 was a criterion for enrollment in the study. Complete recovery from septic shock was defined as discontinuation of any supportive therapies. Severity of illness during septic shock and after recovery was graded using the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. Interventions In each patient, two short corticotropin stimulation tests were done during septic shock and after recovery. Measurements and results Basal cortisol levels recorded during septic shock and after recovery did not differ (medians: 18.8 vs 18.9 μg/dl). However, the response to corticotropin was significantly attenuated during septic shock when compared with the response after recovery (medians: 7.7 vs 14.7 μg/dl;p=0.02). After recovery, patients' stress response was less, as indicated by a reduction in APACHE II scores (medians: 21 vs 5 points;p〈0.01) Conclusions Adrenocortical response to corticotropin is attenuated in patients with septic shock and high-output circulatory failure compared to the response in the much less stressful condition after recovery. The attenuated adrenocortical responsiveness may be explained by effects of circulating mediators from the systemic inflammatory response.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02044113
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 8
    Electronic Resource
    Electronic Resource
    A comparison of the adrenocortical response during septic shock and after complete recovery (1996)
    Springer
    Intensive care medicine 22 (1996), S. 894-899 
    Details
    ISSN: 1432-1238
    Keywords: Key words Septic shock ; Cortisol ; ACTH ; Adrenocortical insufficiency ; Hemodynamics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To compare the adrenocortical response to corticotropin during septic shock and after complete recovery. Design: Prospective clinical study. Setting: Multidisciplinary intensive care unit in a university hospital. Patients: 20 consecutive patients surviving septic shock. All patients met the American College of Chest Physicians/Society of Critical Care Medicine criteria for septic shock. In addition, the presence of high-output circulatory failure with a cardiac index 〉4 l/min per m2 was a criterion for enrollment in the study. Complete recovery from septic shock was defined as discontinuation of any supportive therapies. Severity of illness during septic shock and after recovery was graded using the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. Interventions: In each patient, two short corticotropin stimulation tests were done during septic shock and after recovery. Measurements and results: Basal cortisol levels recorded during septic shock and after recovery did not differ (medians: 18.8 vs 18.9 μg/dl). However, the response to corticotropin was significantly attenuated during septic shock when compared with the response after recovery (medians: 7.7 vs 14.7 μg/dl; p=0.02). After recovery, patients‘ stress response was less, as indicated by a reduction in APACHE II scores (medians: 21 vs 5 points; p〈0.01) Conclusions: Adrenocortical response to corticotropin is attenuated in patients with septic shock and high-output circulatory failure compared to the response in the much less stressful condition after recovery. The attenuated adrenocortical responsiveness may be explained by effects of circulating mediators from the systemic inflammatory response.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050184
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 9
    Electronic Resource
    Electronic Resource
    Effects of administration of somatostatin-14 and immunoneutralization of somatostatin on endocrine and growth responses in rainbow trout (2003)
    Oxford, UK : Blackwell Science Ltd
    Journal of fish biology 63 (2003), S. 0 
    Details
    ISSN: 1095-8649
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Biology
    Notes: Injection of somatostatin-14 (SS-14) at 5 ng g−1 body mass (BM) into rainbow trout Oncorhynchus mykiss decreased (P 〈 0·05, cubic, r2 = 0·54) levels of growth hormone (GH) (1·5 ± 0·9 ng ml−1v. 6·6 ± 0·6 ng ml−1) over time when compared to controls. Somatostatin-14 at 50 ng g−1 BM also decreased (P = 0·064, quadratic; r2 = 0·30) levels of GH (3·6 ± 2·1 ng ml−1v. 6·6 ± 0·6 ng ml−1) over time compared to controls. In a second study, passive immunization against SS-14 (1 : 25 dose) increased (P = 0·10, cubic, r2 = 0·12) levels of GH (11·0 ± 4·8 ng ml−1v. 5·2 ± 1·4 ng ml−1) over time. Passively immunizing against SS-14 (1 : 50 dose) increased (P 〈 0·05, cubic, r2 = 0·10) levels of GH (8·2 ± 2·3 ng ml−1v. 5·2 ± 1·4 ng ml−1) over time compared to controls. Overall, in the active immunization study there was no difference (P 〉 0·10) in specific growth rate (G) or feed conversion ratio (FCR) between the three treatment groups during the 9 weeks of the study. Only four of the fish immunized against SS-14, however, developed antibody titres against SS. Compared to controls, these fish exhibited a G of 0·89 ± 0·09 v. 0·56 ± 0·09% per 3 weeks and FCR of 0·80 ± 0·04 v. 1·20 ± 0·05 g g−1. In SS-14 immunized fish, levels of GH decreased (P 〈 0·05) by day 63 while levels of insulin like growth factor-I (IGF-I) increased (P 〈 0·05) by day 42 and 63. These results indicate the hypothalamic hormone SS-14 regulates GH secretion similarly in rainbow trout as it does in mammals. Active immunization against SS-14 could improve growth performance in rainbow trout but enhanced G and FCR is dependent upon generation of antibody titres.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1095-8649.2003.00177.x
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 10
    Electronic Resource
    Electronic Resource
    Pulmonary artery catheter placement and temporary cardiac pacing in a patient with a persistent left superior vena cava (1991)
    Springer
    Intensive care medicine 17 (1991), S. 507-508 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01690781
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...